title: Acute renal failure and liver dysfunction after subcutaneous injection of 3-sn-phosphatidylcholine (Lipostabil®)-case report.
abstract: BACKGROUND
  Drug-induced tubulointerstitial nephritis and acute tubular necrosis are common, and are often caused by drugs especially antibiotics or non-steroidal anti-inflammatory drugs. Drug-induced liver dysfunction and renal failure after subcutaneous injection of phosphatidylcholine was not reported so far. 3-sn-Phosphatidylcholine has been described as a cell lysis reaction-inducing drug. Its in vitro data indicated a relevant toxicity potential. In particular human cell types such as fibroblast-like preadipocytes, vascular and skeletal muscle cells, or renal epithelial cells react more sensitive than other human cell types.
  
  
  METHODS
  We present a 28-year-old woman who received 3.5 g (70 mL) of 3-sn-phosphatidylcholine (Lipostabil®) at once subcutaneously (s. c.) in both gluteal regions. The drug was originally introduced to prevent fat embolism. Nevertheless, its off-label use in aesthetic therapy for treatment of localized fat deposits through subcutaneous administration is becoming increasingly common. Three hours after injection the patient suffered from severe nausea and emesis. Within 24 hours a dramatic increase of liver enzymes and a beginning liver dysfunction were observed. Subsequently, renal function deteriorated two days later making a temporary haemodialysis necessary. Hepatic improvement was observed after three days of treatment. Renal function was fully recovered after two weeks.
  
  
  CONCLUSIONS
  To the best of our knowledge, this is the first reported patient presenting with acute liver dysfunction and renal failure after subcutaneous injection of 3-sn-phosphatidyl-choline (Lipostabil®) indicating the risk of an off-label use of this drug.
authors.affiliation: Department of Internal Medicine I, Johannes Gutenberg University Hospital, Mainz, Germany. johannes.rey@unimedizinmainz.de
authors.forename: J W
authors.initials: JW
authors.lastname: Rey
authors.forename: O
authors.initials: O
authors.lastname: Schreiner
authors.forename: A P
authors.initials: AP
authors.lastname: Barreiros
authors.forename: M
authors.initials: M
authors.lastname: Heise
authors.forename: M
authors.initials: M
authors.lastname: Krupp
authors.forename: M
authors.initials: M
authors.lastname: Schuchmann
authors.forename: G
authors.initials: G
authors.lastname: Otto
authors.forename: P R
authors.initials: PR
authors.lastname: Galle
authors.forename: A
authors.initials: A
authors.lastname: Teufel
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000175:diagnosis*; D000328:Adult; D005260:Female; D006801:Humans; D007279:Injections, Subcutaneous / Q000009:adverse effects; D009393:Nephritis / Q000139:chemically induced* / Q000175:diagnosis*; D010713:Phosphatidylcholines / Q000009:adverse effects*
chemical_list: D010713:Phosphatidylcholines; C005152:lipostabil